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Wellcare Assist (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellcare Assist (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellcare Assist (HMO-POS) in 2026, please refer to our full plan details page.
Wellcare Assist (HMO-POS) is a HMO-POS plan offered by Centene Corporation available for enrollment in 2025 to people living in Select counties in TN. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Wellcare Assist (HMO-POS) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Wellcare Assist (HMO-POS).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Wellcare Assist (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $23.90. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $4800.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Wellcare Assist (HMO-POS) prescription drug plan features an annual drug deductible of $615. For Tier 6 select care drugs, there is no copay for any supply length at both preferred and standard pharmacies. Additionally, you can benefit from no copay on a three-month supply of Tier 1 preferred generic and Tier 2 generic drugs when using preferred mail order. Tier 1 and Tier 2 generic drugs otherwise require copays ranging from $18 to $60 depending on the pharmacy type and fill duration. For higher-tier prescriptions, Tier 3 preferred brand drugs require a 21% coinsurance, Tier 4 non-preferred drugs have copays starting at $100, and Tier 5 specialty drugs incur a 25% coinsurance for a one-month supply.
Additional Benefits
The Wellcare Assist (HMO-POS) plan offers comprehensive coverage with many services requiring no copay and no coinsurance, including primary care visits, preventive services, and home health care. For specialized care, members pay a low $15 copay for specialist visits and dental services, while inpatient hospital stays require a $325 copay for the first six days of an acute stay. Emergency care is accessible with a $130 copay, which is waived if admitted, and urgent care visits require a $30 copay. This plan also features robust supplemental benefits, including no copay for routine vision and dental exams, along with a $300 annual eyewear allowance and up to $1,500 per ear for hearing aids. Additionally, members can access 24 free one-way transportation trips per year and receive over-the-counter items at no cost. For medical equipment and dialysis services, the plan charges no copay and a standard 20% coinsurance.
Inpatient Hospital See details
Wellcare Assist (HMO-POS) covers inpatient hospital services with no coinsurance, requiring a $325 copay for days 1 to 6 of an acute stay and a $275 copay for days 1 to 6 of a psychiatric stay, followed by no copay for days 7 to 90. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered, and prior authorization is required.
Outpatient Services See details
Wellcare Assist (HMO-POS) covers outpatient hospital services with no coinsurance and copays ranging from no copay to $280, and ambulatory surgical center services with a $125 copay and no coinsurance. Outpatient substance abuse services require a $40 copay and no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Wellcare Assist (HMO-POS) covers partial hospitalization services with a $140.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Wellcare Assist (HMO-POS), with ground and air ambulance services requiring a $300 copay and no coinsurance. Plan-approved transportation services offer up to 24 one-way trips per year with no copay and no coinsurance, but transportation to any health-related location is not covered.
Emergency Services See details
Wellcare Assist (HMO-POS) covers emergency services with a $130 copay and urgently needed services with a $30 copay, both with no coinsurance and copay waivers if admitted to the hospital within 24 hours. Worldwide emergency and urgent services are partially covered up to a $50,000 limit with a $130 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Wellcare Assist (HMO-POS) provides primary care physician services with no copay and no coinsurance, while specialist visits, physical therapy, occupational therapy, and opioid treatment require a $15 copay and no coinsurance. Mental health and psychiatric services have a $40 copay and no coinsurance, but chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive Services are partially covered by Wellcare Assist (HMO-POS), offering an annual physical, fitness benefits, alternative therapies, and select screenings with no copay and no coinsurance. Kidney disease education is covered with no copay and a 20% coinsurance, while several supplemental services—including health education, nutritional therapy, and in-home support—are not covered.
Hearing Services See details
Hearing services are covered by Wellcare Assist (HMO-POS), which offers Medicare-covered exams for a $15 copay and no coinsurance, and annual routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to $1,500 per ear annually, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Wellcare Assist (HMO-POS) vision services are partially covered, as other eye exam services are not covered, with no deductibles or coinsurance. Eye exams carry a $0 to $15 copay (no copay for one routine exam per year), while eyewear is covered with no copay up to a $300 annual maximum for contacts, eyeglasses, lenses, frames, and upgrades.
Dental Services See details
Dental services are partially covered by Wellcare Assist (HMO-POS), with Medicare-covered services requiring a $15 copay and no coinsurance, and preventive and comprehensive services offered with no copay and no coinsurance. Prior authorization is required for most services, and maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Wellcare Assist (HMO-POS) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have a coinsurance of 0% to 20% with no copay.
Dialysis Services See details
Dialysis Services are covered under the Wellcare Assist (HMO-POS) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Wellcare Assist (HMO-POS) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance. Diabetic supplies are also covered with no copay, while diabetic therapeutic shoes and inserts require a 20% coinsurance, with prior authorization required for these benefits.
Diagnostic and Radiological Services See details
Wellcare Assist (HMO-POS) covers diagnostic services with no coinsurance, featuring no copay for lab services and copays up to $20 for diagnostic procedures. Radiological services require prior authorization and range from a $0 minimum copay for diagnostic radiology and a $25 copay for X-rays to a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home health services are covered under the Wellcare Assist (HMO-POS) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under Wellcare Assist (HMO-POS) with no coinsurance, but only some services are covered as standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Wellcare Assist (HMO-POS) covers Skilled Nursing Facility (SNF) care with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 to 20 and days 51 to 100, a $218 daily copay for days 21 to 50, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Wellcare Assist (HMO-POS), which offers over-the-counter items and chronic illness meal benefits with no copay and no coinsurance, while acupuncture is not covered. The meal benefit requires a referral, and over-the-counter items are provided via reimbursement.
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